Srg Compre Exam 5: Multiple Sclerosis, Pulmonary System, Burns And Arthroplasty

The patient's CSF analysis is indicative of Multiple Sclerosis. Multiple Sclerosis is an autoimmune disease that affects the central nervous system, including the brain and spinal cord. CSF analysis is one of the diagnostic tests used to identify Multiple Sclerosis, as it can show the presence of certain abnormalities such as an increased number of white blood cells and the presence of specific proteins. This analysis helps in ruling out other possible causes of the patient's symptoms and confirming the diagnosis of Multiple Sclerosis.

Patients with multiple sclerosis (MS) should avoid exposure to heat because it can worsen their symptoms. Heat can cause temporary nerve damage, leading to an increase in fatigue, weakness, and difficulty with coordination. This phenomenon, known as Uhthoff's phenomenon, occurs due to the sensitivity of demyelinated nerves to elevated temperatures. Therefore, it is important for individuals with MS to avoid hot baths, saunas, and prolonged exposure to hot weather to prevent exacerbation of their symptoms.

Based on the description provided, the burn on the dorsal surface of the patient's arm is mottled red with blisters. This indicates that the burn has affected the epidermis and part of the dermis, which is characteristic of a superficial partial thickness burn. This type of burn typically heals within three weeks, which aligns with the therapist's statement.

Uthoff's phenomenon refers to the temporary worsening of symptoms in patients with multiple sclerosis (MS) when their body temperature rises due to factors such as exercise or heat exposure. One common manifestation of Uthoff's phenomenon is visual blurring, which occurs when the optic nerves are affected by the increased body temperature. This phenomenon is believed to be caused by the demyelination process in MS, where the damaged nerves are less able to conduct electrical impulses when they are heated. Therefore, Uthoff's phenomenon is the correct answer in this case.

The best response would be "Mon, Wed, Fri, 8AM-9AM" because it specifies the days of the week and the time slot for the treatment sessions. This provides a clear and concise schedule for the patient with MS to follow.

Sitting with a forward lean is the correct position to drain the left apico-posterior lobe. This position allows gravity to assist in the drainage process by promoting the flow of secretions from the affected lobe. The forward lean helps to create a downward slope for the secretions to move towards the drainage area, facilitating their removal. Sitting with a backward or sideward lean would not provide the same gravitational assistance, and supine with a forward chin tuck would not create the necessary slope for effective drainage.

Based on the information provided, the patient experiences attacks of signs and symptoms that last for months, but after the attacks, the medications are able to control her symptoms and she is able to go back to work. This pattern suggests that the patient has relapsing-remitting multiple sclerosis (MS). In relapsing-remitting MS, there are clearly defined attacks or relapses followed by periods of partial or complete recovery, which is consistent with the patient's symptoms and response to medication.

The correct answer is supine trendelenburg because this position allows for optimal drainage of the anterior basal segment. In the supine position, the patient is lying flat on their back, while in trendelenburg position, the head of the bed is tilted downward. This combination of supine and trendelenburg positions helps to promote gravitational drainage of the anterior basal segment, which is located at the bottom of the lungs. This position allows for better clearance of secretions and improved ventilation in this specific lung segment.

Boyle's law states that the pressure of a gas is inversely proportional to its volume, when the temperature and amount of gas remain constant. In the context of lung compliance, this principle explains how the lungs expand and contract. When the volume of the lungs increases, the pressure inside decreases, allowing air to flow into the lungs. Conversely, when the volume decreases, the pressure increases, causing air to be expelled. Therefore, Boyle's law is the correct answer as it describes the relationship between lung volume and pressure during breathing.

The immune system cell commonly associated with MS is the T-cell. T-cells play a crucial role in the development and progression of multiple sclerosis (MS). In MS, T-cells mistakenly attack the protective covering of nerve fibers in the central nervous system, leading to inflammation and damage. This immune response is believed to be a key factor in the development of MS symptoms. B-cells are also involved in the immune response in MS, but T-cells are considered the primary immune cells involved in the disease. Basophils and platelets are not typically associated with MS.

The correct answer is 15 degrees wrist extension, 70 degrees MP flexion, PIP and DIP extension, Thumb Abduction using a resting hand splint. This positioning is important to prevent unwanted deformity or contracture of the left hand after a 3rd degree burn. Wrist extension helps to maintain the length of the flexor tendons and prevent flexor contractures. MP flexion allows for functional use of the hand while preventing hyperextension. PIP and DIP extension helps to prevent flexion contractures. Thumb abduction helps to maintain the thumb's functional position and prevent adduction contractures. Using a resting hand splint provides support and maintains the desired positioning.

Patients with multiple sclerosis (MS) often experience worsening of symptoms in hot environments. This is known as Uhthoff's phenomenon, which is characterized by a temporary worsening of neurological symptoms due to increased body temperature. Exercising in warm and humid conditions can increase body temperature and potentially exacerbate symptoms in MS patients. Therefore, it is important to avoid exercising in such conditions to ensure the patient's safety.

The patient is positioned in a prone bed-flat position, which means they are lying face down with their chest on the bed. In this position, gravity helps to drain the posterior (back) segments of the lungs. The superior segment of the left lung is located in the upper part of the left lung, towards the back. Therefore, in the prone position, the PT would be draining the superior segment of the left lung.

Trochanteric osteotomy is performed during THA (total hip arthroplasty) procedures to reduce the risk or lessen the disability caused by the trendelenburg gait post-operatively. The trendelenburg gait is characterized by a dropping of the pelvis on the contralateral side during single-leg stance, which can occur due to weakness or dysfunction of the hip abductor muscles. Trochanteric osteotomy involves cutting and repositioning the greater trochanter of the femur, which can help improve the function and stability of the hip joint, thereby reducing the risk of developing or worsening the trendelenburg gait.

Dawson's Fingers refers to the characteristic pattern of demyelination seen in multiple sclerosis (MS) on MRI scans. These finger-like lesions are formed by the inflammation and destruction of myelin, the protective covering of nerve fibers. The presence of Dawson's Fingers is a strong indicator of demyelination, which is consistent with the patient's complaint of pins and needles sensation on the extremities. Oligoclonal bands, on the other hand, are not specific to MS and can be seen in other conditions as well. Therefore, the correct answer is Dawson's Fingers: areas of demyelination.

In the prone Trendelenburg position, the patient is lying face down with the head lower than the feet. This position allows gravity to assist in draining secretions from the lungs. The posterior basal segment of the lung is located at the back and bottom of the lung. In the prone position, this segment is most effectively drained due to the force of gravity pulling the secretions downwards. Therefore, the correct answer is posterior basal.

After total hip arthroplasty, the most common complication related to physical rehabilitation is the Trendelenburg Gait. This is a gait abnormality characterized by a dropping of the pelvis on the unaffected side during the stance phase of walking. It occurs due to weakness or paralysis of the hip abductor muscles, which are responsible for stabilizing the pelvis during walking. This leads to a lurching or swaying motion of the trunk and can cause difficulty in weight-bearing and balance. Hypoglycemia, Steppage Gait, and Staggering Gait are not commonly associated with total hip arthroplasty.

Wet-to-dry dressings with normal saline 2x a day is the best method of debridement for this patient. The wound has moderate serous fluid drainage and is covered with necrotic and fibrotic tissue. Wet-to-dry dressings help to remove necrotic tissue and promote wound healing by creating a moist environment. Normal saline is used to clean the wound and prevent infection. Scrubbing the wound vigorously can cause further damage and delay healing. Using diluted iodine betadine or whirlpool jet agitation may also be too aggressive for this type of wound.

Physiological dead space refers to the portion of the respiratory system where no gas exchange occurs. It includes both anatomical dead space (the air that remains in the conducting airways) and alveolar dead space (the air that reaches the alveoli but does not participate in gas exchange). Therefore, physiological dead space represents the total amount of lung dead spaces in a normal individual, encompassing both anatomical and alveolar dead spaces.

Prior to the thoracocentesis procedure to drain a large pulmonary effusion on the left lung, the assessment finding that should be documented is a mediastinal shift and a deviated trachea to the right. This is because a large effusion in the left lung can cause an increase in pressure, leading to the displacement of the mediastinum and trachea towards the unaffected side, which in this case is the right side.

In this scenario, the patient with Multiple Sclerosis (MS) experienced sudden fatigue and visual blurring during a rehab session. These symptoms may indicate a temporary exacerbation of the disease known as a relapse. It is important to wait for the symptoms to stabilize before continuing with the treatment. Continuing the session may worsen the symptoms and potentially harm the patient. Therefore, the most appropriate course of action is to wait for the symptoms to stabilize and defer the treatment until the patient is in a more stable condition.

The first statement is true because in multiple sclerosis (MS), there is indeed demyelination of the nerve fibers, which means that the protective covering around the nerves called myelin is damaged. This demyelination disrupts the normal conduction of nerve signals.

The second statement is also true because despite the demyelination, the conduction of action potential in MS is still saltatory. Saltatory conduction refers to the jumping of the action potential from one node of Ranvier to another, which speeds up the conduction process even without a continuous myelin sheath.

Therefore, both statements are true.

When performing a total hip arthroplasty (THA) with a posterior approach, it is important to avoid hip flexion. This is because hip flexion can put stress on the surgical site and potentially dislocate the newly implanted hip joint. By avoiding hip flexion, the risk of complications and dislocation can be minimized.

The BEST dressing for a decubitus ulcer with swelling, redness, pain, and moderate to high wound drainage is a calcium alginate dressing. Calcium alginate dressings are highly absorbent and can effectively manage exudate. They create a gel-like consistency when in contact with wound fluid, which helps to maintain a moist wound environment and promote healing. Additionally, calcium alginate dressings have antimicrobial properties and can conform to the shape of the wound, providing a good fit and preventing further damage.

Interferon Beta is the gold standard medication for patients with MS because it has been extensively studied and proven to be effective in reducing the frequency and severity of relapses, slowing down the progression of disability, and reducing the number of brain lesions in MS patients. It works by modulating the immune system and reducing inflammation in the central nervous system. Other medications like Interferon Y, Dimethyl Fumerate, and Methylprednisolone may also be used in the treatment of MS, but Interferon Beta has the most evidence supporting its efficacy and safety.

The correct answer is "sidelying bed flat" because this position allows for optimal drainage of the right posterior lung segment. By lying on the side with the bed flat, gravity can assist in draining any fluid or mucus from this specific lung segment. This position helps to improve ventilation and prevent complications such as pneumonia or atelectasis.

Cellulitis is a skin disorder that manifests suppurative inflammation of cellular connective tissue close to the skin. It can be contagious and the skin appears to be hot, red, and edematous.

Treatment of postural drainage should be done 2 to 4 times per day. This is the most appropriate guideline for a patient with Cystic Fibrosis who has tenacious, fetid, and purulent sputum, crackles, and increased fremitus. Postural drainage helps to mobilize and remove secretions from the lungs. By performing it 2 to 4 times per day, the patient will have more opportunities to clear their airways and improve respiratory function. The other options do not specify the frequency of treatment or provide specific instructions for postural drainage.

Sidelying head up is the correct answer because it allows for better drainage of the left posterior lung segment. By elevating the head, gravity helps to promote the drainage of secretions and fluid from the lungs, improving ventilation and preventing complications such as pneumonia. This position also helps to reduce the risk of aspiration, as it prevents the pooling of secretions in the lungs. Sidelying bed flat, sidelying bed-bound, and the fetal position do not provide the same benefits for lung drainage as sidelying head up.

The correct answer is to recommend that the patient set an appointment with his doctor and discuss the benefits and disadvantages of using antitussive drugs. This is the best course of action because it allows the patient to have a conversation with their doctor, who can provide personalized advice and guidance based on their specific condition and medical history. It is important for the patient to understand the potential benefits and disadvantages of using antitussive drugs, as well as any alternative treatment options that may be available.

Due to the nature of multiple sclerosis, which affects the central nervous system, individuals may experience muscle weakness, coordination problems, and difficulty with balance and mobility. Looking down to tie shoelaces requires bending the neck forward, which can be challenging for someone with these symptoms.

The first indication of a second degree burn is that it is wet, red, and very painful. Second degree burns involve damage to both the top layer of skin (epidermis) and the second layer of skin (dermis). The wetness is due to the damage to the sweat glands and the redness is caused by increased blood flow to the area. The intense pain is a result of the exposed nerve endings in the dermis. This combination of symptoms is characteristic of a second degree burn.

The presence of edema and ulcer proximal to the medial malleolus suggests a venous ulcer. Venous ulcers are typically caused by chronic venous insufficiency, which leads to pooling of blood in the lower extremities and increased pressure in the veins. This increased pressure can result in edema and the development of ulcers, typically located around the ankle or lower leg. The description of pain in a dependent position is also consistent with venous ulcers, as the pain is often relieved when the leg is elevated.

The patient most likely has venous insufficiency. Venous insufficiency is characterized by symptoms such as edema, brownish discoloration, and skin contraction in the ankle region. The patient's flaky, dry, and scaly skin also aligns with this condition. Cellulitis is unlikely as there is no mention of infection or redness. Age-related trophic changes may cause skin changes, but the presence of edema suggests a vascular issue. Arterial disease typically presents with symptoms such as pain, pallor, and decreased pulses, which are not mentioned in the patient's presentation.

Hydrogel dressings are indicated for patients with superficial to partial thickness wounds that have minimal drainage and are prone to desiccation. These dressings provide a moist environment for the wound, promoting healing and preventing further desiccation. They are especially useful in dry climates where maintaining moisture in the wound is crucial. Hydrofilm dressings are transparent adhesive films used for superficial wounds, hydrogenate dressings do not exist, and semipermeable dressings are used for moderate to heavily exuding wounds.

The Haldane Effect refers to the phenomenon where the binding of oxygen to hemoglobin in the lungs promotes the release of carbon dioxide from the blood. This effect facilitates the left shift of the oxygen-dissociation curve, meaning that hemoglobin has a higher affinity for oxygen, allowing for increased oxygen uptake in the lungs and enhanced oxygen delivery to tissues.

In an anterolateral approach for total hip arthroplasty (THA), the hip external rotation (ER) should be avoided. This is because the anterolateral approach involves cutting through the external rotator muscles of the hip, which can weaken their function. By avoiding hip external rotation, the risk of damaging these muscles or compromising the stability of the hip joint is minimized. Therefore, it is important to adhere to the specific hip precaution of no hip ER in order to ensure a successful outcome and minimize complications following THA with an anterolateral approach.

The adverse effects described, such as tremors, nervousness, confusion, cardiac arrhythmias, and changes in pulse, are consistent with the use of bronchodilators (Salmeterol, Aminophylline, and Albuterol) but not with the use of an anti-histamine like Diphenhydramine. Anti-histamines typically do not cause these types of cardiovascular and neurological side effects.

The amount of air inhaled and exhaled at rest will not be changed in a patient diagnosed with emphysema. Emphysema is a chronic lung disease that affects the alveoli, causing them to lose their elasticity and resulting in air trapping in the lungs. This leads to difficulty in exhaling air, especially during forced expiration. However, the amount of air inhaled and exhaled at rest is not affected by emphysema as it is a passive process that relies on the natural elasticity of the lungs.

Compression stockings are commonly used to improve venous circulation and prevent blood pooling in the lower extremities. However, in patients with chronic arterial disease, the use of compression stockings is contraindicated. Arterial disease refers to conditions that affect the arteries, such as atherosclerosis, peripheral artery disease, or arterial ulcers. These conditions involve reduced blood flow to the extremities, and using compression stockings can further restrict blood flow, potentially worsening the arterial insufficiency. Therefore, compression stockings should not be used in patients with chronic arterial disease.

The patient's increased anterior-posterior chest diameter, hyperinflated lungs, flattened diaphragm, and excessive use of accessory muscles suggest that the patient is experiencing chronic obstructive pulmonary disease (COPD). Pursed lip breathing is a technique commonly taught to patients with COPD to help improve their breathing efficiency. It involves inhaling through the nose and exhaling through pursed lips, which helps to prolong exhalation, reduce air trapping, and improve oxygen exchange. This technique can help the patient manage their symptoms and improve their overall lung function.

Stage 3 is characterized by symptoms such as redness, edema, blistering, hardening of tissue, inflammation extending into the fat layer, and superficial necrosis. In this stage, the ulcer has progressed to the point where it has penetrated through the full thickness of the skin and into the subcutaneous tissue. The ulcer may appear as a deep crater or have a shallow depth, but it is typically accompanied by significant tissue damage. Treatment at this stage focuses on wound care, infection control, and preventing further complications.

The correct answer is "Symmetrical movement of the chest of the neonate, specifically the middle/lingula and lower lobe expansion." This is because during chest expansion assessment, it is important to observe for symmetrical movement of the chest, indicating proper expansion of both lungs. The specific mention of the middle/lingula and lower lobe expansion indicates that all areas of the lungs are expanding properly, ensuring adequate ventilation and oxygenation.

The implication of the finding of hypertrophy of the sternocleidomastoid muscle and visualization of bilateral engorgement of the jugular vein in a patient with Chronic Bronchitis is congestive heart failure. These symptoms suggest that there is increased pressure in the heart and impaired blood flow, leading to fluid accumulation and congestion in the veins. This finding is commonly seen in congestive heart failure, a condition where the heart is unable to pump blood effectively.

The ulcer described in the question involves full thickness dermis and underlying tissues, and may be protruding into the muscle. According to the National Pressure Ulcer Advisory Panel (NPUAP) staging system, this indicates a Stage 3 ulcer. Stage 3 ulcers involve the full thickness of the skin and may extend into the subcutaneous tissue, but they do not involve muscle or bone.

The Bohr effect refers to the phenomenon where an increase in acidity (lower pH) causes a decrease in the affinity of hemoglobin for oxygen. In a normal individual, this effect helps to release oxygen from hemoglobin in tissues with higher metabolic activity. However, in a patient with MS (multiple sclerosis), the pulmonary system is already compromised, and an increase in tissue oxygenation can worsen the signs and symptoms associated with the disease. Therefore, the Bohr effect should be avoided in such patients to prevent any further complications.

Sitting with a backward lean is the correct position to drain the right apical lobe. This position allows for gravity to assist in the drainage of secretions from the lung's apical lobe, which is located at the uppermost part of the lung. By leaning backward, the secretions can flow more easily and be expelled from the lungs, promoting better lung function and clearing any potential blockages.

The therapist is assessing for symmetry of chest movement by checking the lower lobes. Placing the tips of the thumbs along the patient's back at the spinous process (lower thoracic level) allows the therapist to assess for movement and symmetry of the lower lobes. By extending the fingers around the ribs, the therapist can also assess for any abnormalities or restrictions in chest expansion. This hand placement provides a comprehensive assessment of the lower lobes and chest movement.

One of the precautions that needs to be carefully observed when conducting resistance training with a 35-year-old female who has had chronic MS for 10 years is fractures and MS strains. This is because individuals with MS may have weakened bones and muscles, making them more susceptible to fractures and strains during physical activity. Therefore, it is important to ensure proper form and technique during resistance training to minimize the risk of injury.